Effects of a sepsis care incentive policy on emergency treatment outcomes: a nationwide cohort study

Early emergency department (ED) care may improve sepsis outcomes. Taiwan introduced a pay-for-performance Sepsis Care Incentive Policy in 2012. Using Taiwan’s National Health Insurance Research Database, we conducted a retrospective matched pre–post cohort study of hospitalized patients with first-time ED sepsis visits identified by policy-specified ICD-9-CM/ICD-10-CM codes. Patients from 2011 were propensity-score matched 1:1 with those in each post-policy year (2013–2017). Cox models estimated adjusted hazard ratios (aHRs) for all-cause and sepsis-specific 30-day mortality; generalized estimating equations assessed log-transformed hospital length of stay (LOS). After matching, 18,053 pre-policy and 90,265 post-policy patients were included. All-cause 30-day mortality did not differ significantly between periods (aHR 0.98, 95% CI 0.94–1.03). Sepsis-specific mortality was 1.00% before and 0.85% after implementation (aHR 0.83, 95% CI 0.71–0.98). Mean LOS was 13.22 and 12.46 days, respectively (adjusted LOS ratio 0.97, 95% CI 0.96–0.99). The descriptive incentive-record proportion was 5,853 of 122,476 post-policy ED sepsis cases (%); this was not a verified eligibility or adherence rate. The post-policy period was associated with lower sepsis-specific mortality and modestly shorter LOS, without a significant all-cause mortality difference. These early-implementation associations do not isolate the policy’s causal contribution from concurrent changes in care or case ascertainment.